MCQ 7. A Blood Sample is Left on a Phlebotomy Tray for Four Hours

MCQ 7. A blood sample is left on a phlebotomy tray for four hours before it is delivered to the laboratory.

Which group of tests could be performed with the least effect on the results?

a. Glucose, Na, K, CO2 content

b. Uric Acid, BUN, creatinine

c. Total and direct bilirubin

d. CK, ALT, ALP, ACP

e. Lactate and ammonia

Answers

Borderline Diabetes: What You Need to Know

The term borderline diabetes refers to a condition called prediabetes. Prediabetes is a condition in which blood sugar levels are higher than normal but not high enough to be classed as type 2 diabetes.

Prediabetes is to be considered a risk factor for type 2 diabetes. It is estimated that 10 to 23 percent of people with prediabetes will go on to develop type 2 diabetes within 5 years.

Prediabetes can be accompanied by other risk factors. It is associated with conditions such as obesity, especially abdominal obesity, high blood pressure, high blood fat levels and low levels of "good" cholesterol.

When these risk factors "cluster" together in a person, there is a higher risk of not just type 2 diabetes but heart disease and stroke as well.

Read more: Borderline Diabetes: What You Need to Know

Source: medicalnewstoday

Blood Test Uncovers Undiagnosed Diabetes In Hospital Patients

Hyperglycemia is a frequent finding that can be related to physiologic stress, illness and medications, including steroids and vasopressors and glycated hemoglobin (HbA1c) correlates with the average blood glucose level over the previous eight to 12 weeks.

Screening of HbA1c levels plays an important role in the diagnosis and management of diabetes mellitus in the outpatient setting but remains underused in the evaluation of hyperglycemia with undiagnosed diabetes in the inpatient setting.

Read more:   Blood Test Uncovers Undiagnosed Diabetes In Hospital Patients

A point-of-care glycated hemoglobin (HbA1C) analyzer.

Source: labmedica

ERBA Mannheim Clinical Chemistry Analyzer XL-1000

Automated high throughput random access analyzer, it offers continuous sample loading facility using racks. Contrary to other automatic analyzers, the sample loading is automatic instead of manual thereby enhancing precision.

• Throughput of upto 1040 tests/hour with ISE- 800 photometric tests/ hr and 240 tests/ hr with ISE
• Permanent hard glass cuvettes – requiring no replacement for upto 4-5 years
• Direct ISE measurement for Na/K/Cl/Li (optional)
• Auto re-run, auto dilution, reflex testing
• Probes with clot detection & Vertical Obstruction Detection feature
• Low reagent/test consumption -requires reagent volume of just 150 µL, thereby proving to be cost effective for laboratories
• Extensive Quality Control menu (L-J chart, twin plot, QC rules)

Read more: ERBA Mannheim Clinical Chemistry Analyzer XL-1000

Source: ERBA Mannheim

Dimension Xpand Plus Integrated Chemistry System

The Dimension® Xpand Plus integrated chemistry system combines chemistry, STAT and specialty testing on a single, compact, easy-to-use system.

• Full-range integrated capability in a small footprint
• True integration of chemistry and immunoassay for improved workflow efficiency
• Easy-to-use Dimension platform provides the confidence that every trained operator can run any test, any time
• Full disease-state profiling on a single analyzer
• The most commonly ordered panels from a single sample

Read more: Dimension Xpand Plus Integrated Chemistry System

Source: SiemensHealthineers

New Gene Associated With Familial High Cholesterol

The gene that explains one quarter of all familial hypercholesterolemia with very high blood cholesterol has been revealed. Familial hypercholesterolemia is the most common genetic disorder leading to premature death, found in 1 in 200 people.

The reason why lipoprotein(a) concentrations are raised in individuals with clinical familial hypercholesterolemia is unclear. The hypotheses that high lipoprotein(a) cholesterol and LPA risk genotypes are a possible cause of clinical familial hypercholesterolemia, and that individuals with both high lipoprotein(a) concentrations and clinical familial hypercholesterolemia have the highest risk of myocardial infarction.

Read more: New Gene Associated With Familial High Cholesterol

Clinical manifestation of Homozygous Familial Hypercholesterolemia, interdigital xanthoma

Source: labmedica

Fasting no longer necessary before cholesterol test

For the first time, a team of international experts recommends that most people do not need to fast before having their cholesterol and triglyceride levels tested.

Fasting is a problem for many patients, they explain, and note the latest research shows that cholesterol and triglyceride levels are similar whether people fast or not.

The experts represent the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) joint consensus initiative.

They refer to new research from Denmark, Canada, and the United States that included over 300,000 people and found it is not necessary to have an empty stomach to check cholesterol levels.

Apart from Denmark, all countries require that patients fast for at least 8 hours before checking their cholesterol and triglyceride levels - referred to as "lipid profile." In Denmark, non-fasting blood sampling has been in use since 2009.

Read more: Fasting no longer necessary before cholesterol test

Researchers say fasting before a cholesterol test is unnecessary.

Source: medicalnewstoday

Clinical Chemistry Analyser: Vitros 5600

An integrated chemistry analyser - Vitros 5600.

Here is an overview of the Vitros 5600 integrated analyser, a next generation system of Ortho Clinical Diagnostics (a JnJ Company).

Highlights:

• capability to add or remove reagents and consumables, and empty solid and liquid waste while operating;
• sample-centered processing integration approach eliminates need to move sample trays or aliquot samples between chemistry and immunoassay processing modules;
• integrates chemistry, immunoassay, and infectious disease testing, and process them in parallel; 
• integrated MicroTip technology expands menu availability, such as DATs, TDMs, specific proteins, %HbA1c, and user-defined channels;
• MicroSensor technology detects interfering levels of hemolysis, icterus, and turbidity;
• e-Connectivity assists with remote diagnostics, software, and test parameter downloads and updates

Video Link: Vitros 5600

Source: www.orthoclinical.com

Biomarker Predicts Risk of Preterm Birth Earlier

A standard biomarker test offered earlier in pregnancy could potentially help doctors to better identify women at risk of giving birth prematurely, thus enabling health services to focus treatments on women at highest risk.

A number of factors are used to determine if a woman is at risk of giving birth prematurely, including a history of preterm births or late miscarriages. Two further factors which clinicians normally consider are the length of cervix and levels of a biomarker found in vaginal fluid known as fetal fibronectin.

Scientists at King's College London (London, UK) compared measurements of a new fetal fibronectin test in the cervicovaginal fluid of women at 18 to 21 weeks of gestation with measurements made at 22 to 27 weeks of gestation, to see which time period offered the best prediction of spontaneous preterm birth. They also explored whether using a low (10 ng/mL) and high (200 ng/mL) threshold would more accurately classify a women's risk of giving birth prematurely.

Read more: Biomarker Predicts Risk of Preterm Birth Earlier

Fetal fibronectin is a “glue-like” protein that holds the developing baby in the womb

Source: Hologic Inc.

Diabetes Testing on High-Throughput Analyzer Files for FDA Approval

The cobas c513 analyzer has been submitted to the US Food and Drug Administration (FDA) for approval as a dedicated, high-throughput HbA1c testing solution to help laboratories meet increasing testing needs for people with diabetes.

The cobas c513 analyzer from Roche (Basil, Switzerland) is based on the proven, trusted cobas technology developed in cooperation with Hitachi High-Technologies (HHT). The HbA1c test is a longer term measurement of blood sugar levels used to determine if a person has or is at risk of developing diabetes. Set to run on the established Tina-Quant HbA1c A1cDx Gen.3 test, which is also used across the Roche laboratory HbA1c portfolio, the cobas c513 will ensure high-quality results and comply with current guidelines and recommendations for HbA1c testing and measures A1c as defined by the IFCC.

cobas c513 features direct results reporting, thereby minimizing risk of result misinterpretation and eliminating the need to perform time-consuming, manual result interpretation. This feature will help save valuable time and laboratory resources, while ensuring high-quality results. Furthermore, cobas c513 will provide a higher on-board test capacity, enabling laboratories to load the analyzer with more tests at a time, save lab space, minimize resources, and ensure a smooth workflow.

Read more: Diabetes Testing on High-Throughput Analyzer Files for FDA Approval

The cobas c513 analyzer provides throughput of up to 400 HbA1c patient results/hour, closed

tube sampling (CTS), and is standardized according to IFCC transferable to DCCT/NGSP

Source: Roche

Rapid Detection of Urinary Biomarkers with Novel Optical Device

A compact optical device has been developed that can rapidly and sensitively detect biomarkers in urine and has promise for developing simple point-of-care diagnostics of cancer and other diseases.

Micro ribonucleic acids (miRNAs) are a newly discovered class of short, about 19 to 24 nucleotides in length, fragments of noncoding RNAs that are useful biomarkers for diagnosing various diseases, including cardiac disease and some cancers. Since they are surprisingly well preserved in fluids such as urine and blood, their detection is well suited to a rapid, point-of-care method.

Bioengineers at the Agency for Science, Technology and Research (Singapore) have devised a silicon photonic biosensor that can detect tiny changes in the phase of a light beam caused by hybridization between an immobilized DNA probe and target miRNAs in a sample. A laser beam travels through a waveguide, which splits into two arms: a sensing arm in which the light interacts with the sample and a reference arm.

Read more: Rapid Detection of Urinary Biomarkers with Novel Optical Device

Image: Schematic diagram of the MZI biosensor system for miRNA detection.

(a) TEM image of the cross section of a silicon nitride slot wave guide; SEM images of

(b) a strip-slot wave guide mode converter and (c) a silicon nitride grating coupler.

(d) Image of MZI biosensor platform

Source: Agency for Science, Technology and Research

Free eBook - Teitz Fundamentals of Clinical Chemistry

A condensed, student-friendly version of Tietz Fundamentals of Clinical Chemistry, this text uses a laboratory perspective to provide you with the chemistry fundamentals you need to work in a real-world, biomedical laboratory. Accurate chemical structures are included to explain the key chemical features of relevant molecules. Offering complete, accurate coverage of key topics in the field, it's everything that you expect from the Tietz name!

Key Features:

• More than 500 illustrations and easy-to-read tables help you understand and remember key concepts.
• Key words, learning objectives, and other student-friendly features reinforce important material.
• Chapter review questions are included in an appendix to test your knowledge.
• A two-color design makes it easier to read and easy to find important topics.
• In-depth, reader-friendly content is appropriate for MT/CLS and MLT/CLT students and may also be used by laboratory practitioners, pathology residents, and others.

Series: Tietz Fundamentals of Clinical Chemistry 

Hardcover: 976 pages

Publisher: Saunders; 6 edition (November 20, 2007)

Language: English

ISBN-10: 0721638651

ISBN-13: 978-0721638652

This eBook has been published by Comanche County Memorial Hospital School of Medical Technology

Download here: Tietz Fundamentals of Clinical Chemistry

Source: Comanche County Memorial Hospital School of Medical Technology

Can diabetes be cured?

What Causes Diabetes?

Scientists don’t know exactly what causes diabetes. They think that type 1 diabetes is a disease in which your immune system attacks your own cells as if they were foreign invaders. This is called an autoimmune disease. In type 1 diabetes, your immune system attacks your pancreas cells and destroys their ability to make insulin. Most scientists believe that an environmental factor, such as a virus, triggers this process in your body. Your genes play a role as well. Certain people are more prone to develop diabetes.

Likewise, health experts don’t fully understand what causes type 2 diabetes. They do know that it is closely linked to obesity and it tends to run in families. Type 2 diabetes is the most common type of diabetes but you can prevent it in many cases. If you have type 2 diabetes, you may be able to reverse or control high blood sugar through diet and exercise. However, you will always have diabetes and you will always need to manage it to prevent serious health problems.

Is There a Cure for Diabetes?

Both type 1 and type 2 diabetes are chronic, lifelong conditions. Currently, there is no permanent cure for either type. However, there is hope in research for a cure and in prevention. While you can’t prevent type 1 diabetes, you may be able to prevent type 2 diabetes. Maintaining a healthy weight, eating a healthy diet, and exercising regularly are all ways you can help prevent type 2 diabetes.

Read more: Can diabetes be cured?

Source: internetmedicine

Apolipoproteins - Novel perspectives and other challenges.

Atherosclerotic cardiovascular diseases (CVD) are the leading cause of death in the West, and dyslipidemia is considered to be one of their key risk factors. The majority of CVD cases could be prevented by effective management of dyslipidemia. The use of new biomarkers like apolipoproteins as part of extended lipid profiles may be among the most significant new tools for such a task.

Dyslipidemias

Dyslipidemias cover a broad spectrum of lipid abnormalities. Clinicians have so far paid maximum attention to elevated levels of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C). Many other types of dyslipidemias, however, also appear to enhance the risk of CVD. 

Lipid metabolism can become imbalanced or disturbed in several ways, resulting in changes to plasma lipoprotein function and thereafter to the development of atherosclerosis. Many patients who have high cardiovascular risk still have unfavorable lipid profiles.

Given the fast-growing interest in lipidology, clinicians have sought ways to apply evidence-based medicine daily in dyslipidemia management. There are several lipid guidelines from professional societies in different parts of the world to diagnose and make assessments of dyslipidemia. 

The role of apolipoproteins

In recent years, both Europe and the US have witnessed revisions in CVD guidelines and in the approach to lipid profiling. One major new area of attention is the role of apolipoproteins.

Read more: Apolipoproteins - Novel perspectives and other challenges.

Source: cli-online

Novel Blood Test Diagnoses Alzheimer's At Early Stage.

A blood test has been developed that may potentially facilitate detection of Alzheimer's disease at an early stage and it is based on an immuno-chemical analysis using an infrared sensor. 

A major problem of Alzheimer's disease (AD) diagnosis is the fact that, by the time the first clinical symptoms appear, massive irreversible damage to the brain has already occurred and at that point, symptomatic treatment is the only available option.

Scientists at the Ruhr-University Bochum (Germany) and their colleagues analyzed the secondary structure of Amyloid-beta (Aβ) peptide in cerebrospinal fluid (CSF) and blood plasma of 141 patients which was measured with an immuno-infrared-sensor. The sensor's surface is coated with highly specific antibodies which extract biomarkers for Alzheimer's from the blood or the CSF, taken from the lower part of the back. The infrared sensor analyses of the biomarkers showed pathological changes, which can take place more than 15 years before any clinical symptoms appear.

Read more: Novel Blood Test Diagnoses Alzheimer's At Early Stage.

Source: slideshare, labmedica

Clinical Chemistry Guide to Scientific Writing

Clinical Chemistry is pleased to present the Clinical Chemistry Guide to Scientific Writing, a series of educational articles on how to design and write scientific research papers for publication. These articles will help authors, educators, researchers, training program directors, and other professionals write more clearly and effectively, thereby improving their chances for success. We encourage educators and training program directors to use them as a teaching aid, and provide a link to them on their own Web sites.

These articles are easy to read and humorous at times, yet are full of useful information and examples to illustrate important points. Because the articles will benefit anyone interested in scientific writing, we are making them available not only to subscribers, but to all scientists. Translations into Chinese and Spanish are available. We welcome your feedback and suggestions regarding aspects of the writing process about which you would like to learn more.

Read more: Clinical Chemistry Guide to Scientific Writing

Source: 123rf

Pre-Analytical Errors in Biomedical Chemistry Laboratory

Detecting and minimizing pre-analytical variables in clinical analysis

Pre-analytical variables refers to any and all procedures that occur during sample collection, prior to sample analysis. This involves patient identification, physical sample collection, sample transportation to the testing site and sample preparation. 

Pre-analytical errors account for 32%-75% of laboratory errors1. These errors can have a significant impact on laboratory results and it is imperative that laboratory personnel are able to spot these erroneous results, rather than falsely attributing them to an underlying medical cause.

External pre-analytical variables

Some factors such as exercise, eating, drinking and medication can affect patient results. Eating and drinking affects glucose, triglycerides, alkaline phosphatase, alanine, aminotransferase, inorganic phosphate, cholesterol, folic acid, urea, potassium and more. It is recommended that a fasting sample be taken if these sensitive parameters are to be measured.

Exercise should not be undertaken immediately before blood tests such as CK, AST and LDH. In some cases, medication may be postponed for several days until a blood test can be taken, unless the blood test is for therapeutic drug monitoring purposes.

Read more: Pre-Analytical Errors in Biomedical ChemistryLaboratory

Pre-analytical variables account for 32%- 75% of laboratory errors

Source: selectscience

Troponins as cardiac injury markers

Cardiac injury occurs when there is disruption of normal cardiac myocyte membrane integrity. This results in the loss into the extracellular space (including blood) of intracellular constituents including detectable levels of a variety of biologically active cytosolic and structural proteins, referred to as biomarkers, such as troponin, creatine kinase, myoglobin, heart-type fatty acid binding protein, and lactate dehydrogenase. Injury is usually considered irreversible (cell death), but definitive proof that cell death is an inevitable consequence of the process is not available. 

When a sufficient number of myocytes have died (myocyte necrosis) or lost function, acute clinical disease is apparent. Ischemia, with or without infarction, consequent to an imbalance between the supply and demand of oxygen (and nutrients) is the most common cause of cardiac injury. Other causes include trauma, toxins, and viral infection.

The biochemical characteristics and utility of troponins, the diagnosis of cardiac injury, and acute myocardial infarction (MI) in particular will be reviewed here. The other biomarkers of cardiac injury and disease states, other than an acute MI, in which elevation of biomarkers are seen are discussed separately.

Read more: Troponins as cardiac injury markers

Source: sciencsnutshell

Troponin I and Brain Natriuretic Peptide Antibodies as new Generation of Cardiac Markers.

HyTest specialists have been involved in cardiac troponin I (cTnI) studies for more than 15 years. Currently many well characterised antibodies directed to different regions of the cTnI molecule are available. Many of these antibodies are used in commercial assays. The company has determined antibody pairs and combinations useful for the development of high sensitivity cTnI assays, and also validated pairs suitable for lateral flow assays. A new generation of cTnI antibodies is currently under development.

Work with brain natriuretic peptides is ongoing, and BNP, proBNP and NT-proBNP antibodies and antigens are available. In addition a new type of BNP/proBNP immunoassay, the "single epitope" sandwich assay, has been developed, which differs from the conventional format of sandwich immunoassays. In the single epitope sandwich assay, the capture antibody recognises the antigen (BNP or proBNP), whereas the detection antibody is specific to the complex of capture antibody and antigen. The single epitope sandwich approach has great advantages compared with conventional assays, especially in the case of unstable antigen detection. HyTest holds the intellectual property rights for this invention.

Read more:
Troponin I and Brain Natriuretic Peptide Antibodies as new Generation of Cardiac Markers.

Source: cli-online, bpac, stmd

Clinical Considerations for High-Sensitivity Cardiac Troponin Assays.

Cardiac troponins (cTn) have been available for nearly 2 decades in clinical laboratories and are now considered the gold standard for biochemical detection of myocardial infarction (MI). Furthermore, multiple organizations have endorsed the biomarkers’ use in both clinical and analytical guidelines. Today, the universal definition of MI includes the typical rise and/or fall of cTn with at least one value above the 99th percentile of a healthy reference population accompanied by at least one of the following clinical factors: presence of ischemic symptoms; electrocardiographic changes; or imaging evidence of loss of viable myocardium or a new wall motion abnormality.

However, a growing body of evidence now suggests that very low cTn values are clinically important. Investigators have found that patients who have cTn elevations considered normal, but near the 99th percentile, have worse prognoses and require more aggressive clinical management. These findings have prompted the search for newer techniques to enhance precision and enable measurements of cTn at or even below the 99th percentile cutoff.

Recently, researchers and commercial manufacturers have developed several high-sensitivity assays for cardiac troponin (hs-cTn) that are expected to be available soon for routine clinical use in the U.S. Understanding their analytical and clinical performance will be extremely important because under the current MI definition, a significant proportion of the general population would have evidence of myocardial injury. In this article, we will review the basic analytical and clinical characteristics of hs-cTn assays that are important for laboratory professionals to understand and describe how best to help clinicians employ these powerful assays.

Read more:
Clinical Considerations for High-Sensitivity Cardiac Troponin Assays.

Source: aacc, shutterstock